ACA Marketplace insurers are proposing a median premium increase of 14% for 2027, marking a second consecutive year of double-digit hikes, according to a new analysis of preliminary rate filings from 77 insurers across 16 states and Washington, D.C.
If approved, these increases would mean that typical ACA insurance premiums jump by more than one-third between 2025 and 2027, compounding affordability pressures on millions of Americans already struggling with rising healthcare costs.
The underlying cost of medical care and prescription drugs has risen by 10% for 2027, higher than the 8% average growth seen over recent years, according to the Peterson-KFF Health System Tracker. Insurers cite hospitalizations, physician visits, and specialty drugs—including expensive GLP-1 medications—as key cost drivers. Labor shortages and general economic inflation have also pushed up provider wages and reimbursement rates, with some hospital systems requesting double-digit increases in contract negotiations.
Last year’s median proposed rate increase was 18%, with finalized rates reaching 20% in 2026, following the expiration of enhanced premium tax credits at the end of 2025. That expiration triggered a sharp drop in ACA enrollment as healthier enrollees left the marketplace when their subsidies decreased, leaving behind a sicker and more expensive-to-cover population. For 2027, insurers estimate that the deteriorated risk pool—caused by the loss of those healthier members—will drive premiums up by roughly four percentage points higher than they otherwise would be, a dynamic they expect to continue into next year.
Most people enrolled in ACA plans receive a federal subsidy and remain largely shielded from premium increases if they stay in their current plan. However, those earning more than 400% of the federal poverty level—about $62,600 annually for a single person in 2026—lost all subsidies when the enhanced credits expired, leaving them to bear the full cost of rising premiums. This group has seen dramatic increases: a 40-year-old in Indianapolis earning $65,000 faced a monthly premium of $316 with enhanced credits in 2025, which jumped to $477 in 2026 and is projected to reach $546 in 2027 if rates are approved—a cumulative increase of 41% over just two years.
Among the 77 insurers analyzed, most are requesting increases between 10% and 20%, with 20 insurers seeking hikes exceeding 20%. Individual increases range from 1% to 52%, though no insurer proposed decreasing premiums. The deadline for 2027 rate submissions is July 15, and final rates will be approved in late summer.
Federal policy changes have also contributed to the upward pressure. The Trump administration’s Marketplace Integrity and Affordability Rule and the 2027 Notice of Benefit and Payment Parameters have been cited by some insurers as factors driving costs. Additionally, the budget reconciliation legislation signed into law in July 2025, known as the Working Families Tax Cut Act, changed eligibility rules for certain populations, affecting the composition and health status of the marketplace risk pool.
Sources
- Peterson-KFF Health System Tracker — analysis of 77 insurers’ preliminary rate filings showing median 14% premium increase for 2027, drivers of costs including medical trend at 10%, and impact of enhanced credit expiration on risk pool
- KFF — preliminary rate filing analysis confirming 14% median increase, two consecutive years of double-digit hikes, and impact of subsidy expiration on enrollment and morbidity
- Healthcare Finance News — reporting on ACA premiums proposed to increase 14% in 2027
- USA Today — coverage of median rate hike of 14% for 2027 ACA plans
